obstetric emergencies dr mohamed abdul hakim kotb,mbbch,msc,md anaesthesia & icu

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Obstetric Emergencies Dr Mohamed Abdul Hakim Kotb,MBBCH,MSC,MD Anaesthesia & ICU Slide 2 Obstetric emergencies Massive obstetric haemorrhage Non-haemorrhagic shock: Amniotic fluid embolism Acute uterine inversion Shoulder dystocia Eclampsia Cord prolapse Cardiac Arrest AnaphylaxisTRAUMA Slide 3 BASIC PRINCIPLES FOR OBSTETRIC EMERGENCIES. Physiological changes in pregnancy modify: Presentation of the problemPresentation of the problem Normal physiological variablesNormal physiological variables Response to treatmentResponse to treatment Both mother & fetus are affected by the pathology & subsequent treatment. Mothers welfare always takes precedence over fetal concerns --- Fetal survival is usually dependant on optimal maternal management. Slide 4 Slide 5 MASSIVE OBSTETRIC HAEMORRHAGE Major contributor to maternal mortality Definition Blood loss requiring replacement of patients total blood volume Transfusion requiring > 10 u of blood in 24 hs 50% replacement of blood vol. Risk Factors Macrosomia (>4kg) maternal diabetes post dates maternal obesity high maternal wgt gain in pregnancy advanced maternal age previous large infant previous shoulder dystocia Intrapartum protracted late active phase prolonged 2nd stage delay in head descent in 2nd stage mid-pelvic operative delivery The combination of macrosomia and delay in 2nd stage predicts 35% of shoulder dystocia Slide 28 Eclampsia 1/1500 Slide 29 Complications Cerebrovascular injury pulmonary oedema coagulopathy maternal/fetal death HELLP syndrome Slide 30 Presentation Hypertension, hyperreflexia, clonus, headache, visual changes, seizure 20% have diastolic BP5 rads Chest x-ray < 5 rads Chest x-ray < 5 rads Pelvic film